Bariatric Procedure Trends
Q: Is bariatric procedure growth weakening, and how does it affect guidance?
A: Bariatric procedures have decelerated to be flat year-over-year, and it's uncertain whether the trend will worsen or improve. " The low end of our guidance assumes further weakness in bariatric procedures, while the high end assumes flat to slightly positive growth. "

da Vinci 5 Supply Constraints
Q: When will supply constraints for da Vinci 5 be resolved and trigger full launch?
A: We are optimizing the supply chain and ensuring quality, which will continue through all of 2024 and into early 2025. " Incorporating customer feedback and adding feature enhancements are also part of our plan. " We don't expect significant changes to this timeline. "

China Pricing Pressure
Q: Is lower pricing in China temporary or permanent, and what's the competitive situation?
A: Lower pricing in China is primarily due to competition from domestic robotic players. " We have introduced a domestically manufactured Xi system, allowing us to participate in tenders requiring local production and to segment on price. " Pricing pressure is expected to continue due to the competitive environment. "

System Placement Outlook
Q: Could system placements be higher in 2024 despite previous expectations?
A: We expect trade-in volumes to decline in 2024 due to limited supply of da Vinci 5 and a smaller remaining installed base of third-generation Si systems. " Overall system placements may be choppy as customers might choose to wait for da Vinci 5. " We generally do not provide specific guidance on system placements. "

Procedure Volume Growth
Q: What's driving the strong procedure volume, and is it sustainable?
A: We saw particular strength in the U.S. and U.K., with continued growth in procedures beyond urology, including cancer procedures like colorectal, thoracic, and hysterectomy. " Early-stage growth in benign procedures in international markets also contributed. " While we raised guidance slightly, we're monitoring sustainability carefully. "

da Vinci 5 Features and New Indications
Q: How might da Vinci 5's features allow for new procedures?
A: da Vinci 5 offers better imaging, precision, and high performance, enabling subtle and fine surgical motions. " While current indications largely mirror those of Xi and X systems, we're evaluating additional clinical indications that may require FDA discussions. "

Ion Growth and Supply Issues
Q: Is Ion's growth sustainable despite supply challenges?
A: We experienced a partial recovery this quarter but haven't fully resolved catheter and vision probe supply issues. " There's a backlog pending supply stabilization. " Growth is driven by placements in both existing and new accounts, including greenfield opportunities. "

Force Feedback Instruments Impact
Q: Feedback on force feedback instruments and plans to expand the portfolio?
A: Clinicians are exploring the benefits of force feedback instruments, which have sensitive sensors reporting tissue contact forces. " Using force reflection, surgeons can reduce the force applied to tissue, potentially improving patient outcomes. " We aim to make these instruments robust at scale before expanding the portfolio. "

SP Platform in Europe and U.S. Implications
Q: How does SP's indication expansion in Europe affect the U.S. market approach?
A: Early uptake and excitement in Europe are encouraging. " Success in markets like Korea and Japan is informing our approach. " We have submitted for additional indications in the U.S. and are conducting IDE trials, which may accelerate U.S. indications over time. "